Uganda Field Report: 2015

Published on October 29, 2015
Ugandans may struggle against a lack of standardized acute care and serious time delays in receiving such care, but at least in Dr. Joseph Kalanzi they have a tireless EM advocate.

Imagine arranging to meet your friend in Kampala, Uganda for dinner one night, and then seeing his body at the dissection table at the medical school the following week. For Dr. Joseph Kalanzi, hearing news of a loved one in a motorcycle accident was and is still commonplace in his hometown of Kampala. This particular fatal incident, however, provoked him to dedicate his life to improving acute care in Uganda.

Currently, acute care in Uganda is not universal and not standardized. Ambulances, which are only accessible to those living in cities and with private insurance, are only for transport—no care is provided en route. “Good Samaritans” who drive injured patients to the hospital themselves are almost non-existent since the police will question them on why one would perform such an altruistic act. Upon arrival at the hospital, the patient could be triaged or sent to the back of a queue, depending on which hospital the patient is taken to—not based on the condition of the patient. Doctors are only exposed to emergency medicine through a short training course during their anaesthesia block in medical school. Most nurses do not understand the concept of triage, and few are trained in basic first aid. Dr. Kalanzi recalls a good friend who lost her three-year-old daughter from choking on a candy; his friend is a nurse who did not have basic life support training to save her own daughter. It is, therefore, not surprising that the average life expectancy of a Ugandan is 53 years and 56 years for a man and woman, respectively (2015 est.).

Dr. Kalanzi vividly remembers losing three of his closest colleagues during medical school from easily treatable conditions, and he discovered that improving acute care systems was the best way to put a halt to these unnecessary deaths. He is currently part of a technical working group at the Ministry of Health in the development of the Ugandan National Ambulance Service (UNAS), and he is also part of the Emergency Medicine Development Committee at Makerere University.

Dr. Kalanzi believes that a developed and functioning acute care system with trained professionals and well-equipped hospitals and ambulances is an imperative. So many lives are lost due to the time delay from the accident to receiving definitive care. And if patients do make it to the hospital, there are problems with infrastructure, resources, and a lack of trained health care workers.

Follow Kalanzi’s journey on the Ugandan EM official blog: http://www.emergencymedicineuganda.com

The biggest challenge he faces now is the bureaucracy in the creation of training programs in the existing structure. For example, the global agenda has forced Uganda to put in place a system for HIV, tuberculosis, and maternal & child health. These are separate entities, however, and do not cover the holistic and systematic improvements needed for a coordinated, national emergency medical system. As a result, there are problems at the community, district, and national levels, wherein certain diseases are “prioritized” with funding, and millions of lives pay the price.

Dr. Kalanzi recognizes the need to advocate for his specialty at the national level in order to push for the development of acute care systems. There is a need for acute care services, but general awareness is nearly non-existent. Simultaneous coordination is also needed at the local level: within the community, within all allied health professionals (nurses, paramedics, and doctors), and communication across all of those levels. Only then can there be a shift in paradigm toward efficiency and time-sensitive delivery of care.

In addition to his roles in the Ministry of Health and Makerere University, Dr. Kalanzi is also the membership committee chair for the African Federation for Emergency Medicine (AFEM) and the president of Emergency Medicine Uganda (EMU). Guided by his belief that access to acute care services is a basic human right, no matter where or who you are, Dr. Kalanzi works tirelessly to bring Uganda to an international standard of care and to hold the right people accountable for it, regardless of Uganda’s resource limitations.

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